Bilioma: Causes, Symptoms, Localization, Diagnosis, Risk Factors and Treatment

It is a process of encapsulation of bile within the abdomen, which is contained or surrounded by epithelial cells. It appears after a laceration in the bile duct.

These are groups of tightly compressed cells that form an intra-abdominal tissue capable of creating adhesions on the surfaces of biliary organs and tissues.

In this way it is possible to avoid through encapsulation, that the bile reaches the rest of the peritoneal cavity.

The bilioma can be located intra or extrahepatic.

Risk factor’s

The bilioma is also known as a biliary cyst. These cysts can be presented to any person for several reasons.

The patients who present a higher risk of the pathology are those who underwent surgery such as the cholecystectomy procedure or who have liver damage in their medical history. A cholecystectomy is a surgical procedure that is done to remove the gallbladder.

In general, patients subjected to this type of intervention are at risk and are continuously monitored and controlled.

All this with the aim of identifying any signs of post-surgical complication, before more severe pathologies that could cause even death.

Causes

Because they are an accumulation of bile within your abdomen, there are several common reasons for you to develop a bilioma. It could be due to problems with the bile duct or damage to your liver. It can also occur due to trauma or an iatrogenic injury

Bile is a liquid that is produced in the liver and plays a role in your digestive process. The bile duct is what transports bile.

symptom

The symptoms associated with this pathology are very variable and present themselves in very different ways in each patient, being able to generalize with the following:

  • Symptoms of sensitivity or abdominal pain may occur.
  • You may experience confusion and fever, fever is not a usual symptom but is associated with infectious diseases.
  • It is possible to experience pain in the right hypochondrium.
  • There may be abdominal distension, accompanied by flatulence and a feeling of fullness.
  • Jaundice is commonly observed .

Location

Usually the biliomas are in the right hypochondrium, however it is possible that they are located in the left hypochondrium due to the migration of bile.

Subphrenic and subhepatic bile collections are the most common, those associated with trauma and surgery are less frequent and spontaneous subcapsular hepatic bileomas are rarely observed.

Diagnosis

The diagnosis of a bilioma is made using ultrasound images (ultrasound) and computerized axial tomography (CT).

To confirm the diagnosis, a needle aspiration is performed.

Now, if the encapsulation has a deposit of bile, it will appear in the images and in the sample a greenish liquid will be observed (bile) but its color can be affected by the presence of blood or exudate product of the infection.

To carry out the differential diagnosis of the bilioma, other similar pathologies must be taken into account, within which we have:

  • Seroma: Accumulation of serum, lymph and liquid fat.
  • Lymphocele: Cystic structure produced by a lesion of the lymphatic vessels.
  • Hematoma: Accumulation of blood by rupture of capillaries.
  • Hepatic abscess: Collection of pus located in the liver, the result of an infectious process with destruction of the hepatic stroma and parenchyma.
  • Pseudocyst and hepatic cyst: An encapsulation of fluid but not communicating with the bile duct, the wall of the well-defined capsule is observed in the CT scan.

It is very important in the diagnosis, in addition to the appreciation of the physical examination, to take into account the findings of the biopsy of the content of the aspiration, the results presented in the imaging studies and the location of the lesion.

Because these tests allow differential diagnosis and distinguish biliomas from other very similar pathologies.

Treatment

In a bilioma that presents a small size, the treatment is often very conservative, since usually in these cases, the pathology disappears when the body reabsorbs the bile content encapsulated in the bilioma.

If, on the contrary, it is a large bilioma, the ideal is to perform a drainage.

This procedure can be surgical or percutaneous and is performed through a pigtail catheter , by means of endoscopic sphincterotomy or endoscopic nasobiliary drainage.

In the event that an infectious process develops, it is necessary to supply medications such as antibiotics and inflammatories.